Gliederung

Objective: To Discuss disagreement in selection of adverse outcomes while elaborating a Guideline.

Background: CPG approach usually diagnosis or treatment of diseases, and not on how to use intermediary process (i.e., intravenous therapy). While relation between intervention and outcomes are considered direct, this relationship is indirect with intermediary process. Where the intermediary process behaves like a silent witness factor. Therefore authors could have difficulties to understand outcomes as a consequence of the intermediary process.

Material and methods: Using the GRADE system, an authors panel selected the clinical importance between a list of 22 proposed results related to intravenous lines. In a two-round individually voting 14 panelists scored the adverse outcomes with a 1–9 point scale. We developed a discussion meeting on the clinical relevance of the proposed outcomes in between both rounds. We calculated the median and frequency of deviations from the median in plus/minus three points of the scale, to check dispersion among experts.

Results: We found great differences between the two rounds (see table). In the second round, death passes from the fifth to the first in importance with nearly unanimous decision.

Conclusions: Outcomes perceived to be indirectly related to the intervention are considered of little importance, in spite of its great clinical relevancy (death). It seems that raters could be first considering the probability or frequency for the outcomes to take place, than the importance of the result same for the patients.